The Zika AIRS (ZAP) Project Indoor Residual Spraying (IRS 2) Task Order Six ZAP DOMINICAN REPUBLIC END OF YEAR REPORT JANUARY 1, 2018 - DECEMBER 31, 2018 Recommended Citation: Zika AIRS Project (ZAP). February 2019. End of Year Report. Rockville, MD. Abt Associates Inc. Contract No.: GHN-I-00-09-00013-00 Task Order: AID-OAA-TO-14-00035 Submitted to: United States Agency for International Development Submitted: February 14, 2019 Abt Associates Inc. 1 6130 Executive Boulevard 1 Rockville, Maryland 20852 1 T. 301.347.5000 1 F. 301.913.9061 1 www.abtassociates.com ZAP DOMINICAN REPUBLIC END OF YEAR REPORT JANUARY 1, 2018 – DECEMBER 31, 2018 The views expressed in this document do not necessarily reflect the views of the United States Agency for International Development or the United States Government. 3 CONTENTS Acronyms… .................................................................................................................................. iv 1. Executive Summary............................................................................................................... 1 2. Progress and Outcomes ........................................................................................................ 2 2.1 Community Mobilization, Social and Behavior Change Communication................................... 2 2.2 Vector Control................................................................................................................. 2 2.3 Entomological Monitoring .................................................................................................. 4 2.4 Environmental Compliance and Security............................................................................ 10 2.5 Monitoring and Evaluation................................................................................................ 11 2.6 Challenges… .................................................................................................................. 11 3. Improving Zika Response.................................................................................................... 13 3.1 Training and Institutional Capacity Building ........................................................................ 13 3.2 Government Engagement................................................................................................. 13 3.3 Innovations 14 3.4 Integration of Cross-cutting Issues.................................................................................... 14 3.4.1 Gender Equality and Female Empowerment..............................................................................14 3.4.2 Youth 14 3.4.3 Policy And Regulatory Reform..................................................................................................... 15 4. Learning ................................................................................................................................ 16 4.1 Pilots or Research........................................................................................................... 16 4.2 Publications and Presentations.......................................................................................... 17 5. Sustainability and Exit Strategy.......................................................................................... 18 Annex 1A. Monitoring and Evaluation: Zika Framework........................................................ 20 Annex 1B. Monitoring and Evaluation: ZAP M&E PLAN (MEP)............................................ 21 Annex 2. Environmental Mitigation and Management Report............................................... 27 Annex 3. Training Report........................................................................................................... 35 Annex 4. Collaboration............................................................................................................... 36 Collaboration with Other USAID or USG Activities..........................................................................36 Collaboration and/or knowledge sharing with Partner Entities in Host Government and other Donor Agencies ................................................................................................................................... 36 ACRONYMS BG Trap Biogents BG-Sentinel Trap BMP Best Management Practices Bti Bacillus thuringiensis israelensis CECOVEZ Center for Prevention and Control of Vector-borne Diseases and Zoonosis (formerly CENCET) CDC Centers for Disease Control and Prevention DPS/DAS Dirección Provincial/Area de Salud (Provincial/Area Health Directorate) HH Household IRS Indoor Residual Spraying M&E Monitoring and Evaluation MOH Ministry of Health PAHO Pan American Health Organization PMI President’s Malaria Initiative PPE Personal Protective Equipment SBCC Social and Behavior Change Communication SINAVE Sistema Nacional de Vigilancia Epidemiologica (National Epidemiological Surveillance System) UASD Universidad Autonoma de Santo Domingo USAID United States Agency for International Development VC Vector Control WHO World Health Organization ZAP Zika AIRS Project iv 1. EXECUTIVE SUMMARY The overall goal of the Zika AIRS Project (ZAP) is to reduce the burden of vector-borne diseases by enhancing the ability of the United States Agency for International Development (USAID) to implement mosquito control programs in Latin America and the Caribbean, including in the Dominican Republic (DR). ZAP DR includes the following technical components: (1) vector control, (2) entomological monitoring, and (3) capacity building. Under vector control, in 2018 ZAP DR tested the effectiveness of larviciding with Bacillus thuringiensis israelensis (Bti) in Espaillat Province to reduce mosquito density, in collaboration with the Provincial Health Directorate (Dirección Provincial de Salud, DPS). This approach included the dissemination of preventive messages and environmental clean-up activities. Results suggest that Bti along with social and behavior change communication and environmental clean-up had a positive effect on the reduction of larvae, pupae, and adult mosquitoes in the intervention sites. ZAP covered 95 percent of households in Espaillat through vector control visits with an 84 percent pupae reduction in positive containers after applications of Bti. The total number of people protected was 108,833, including 1,223 pregnant women, 27,548 women of reproductive age, and 9,090 children under the age of five. This result supports recommending the future use of Bti to the Ministry of Health (MOH). ZAP DR also conducted a pilot test of lethal ovitraps in Monte Plata Province as a potential complementary vector control intervention. Although the effectiveness of ovitraps with Bti was clear, (none of the deposited mosquito eggs resulted in any offspring), this approach had a limited impact on reduction of adult mosquito density because there were other breeding sites in the intervention areas that were not controlled (Bti was not applied in the municipality at the time of the pilot). The main lesson learned was that lethal ovitraps could be effective in combination with other vector control interventions. In 2018, ZAP DR continued entomological monitoring support with the deployment of ovitraps in six provinces. This ZAP activity evolved toward transition over the course of the year, whereby DPS teams became capable of overall ovitrap management with limited ZAP support. This activity supports ZAP’s emphasis on sustainability. In addition to ovitraps, the ZAP team carried out entomological monitoring of the vector control activities in Espaillat and Monte Plata that were mentioned above. The project’s entomology team conducted baseline, follow-up, and post-intervention data collection to assess progress of the vector control work. The entomology team also continued insecticide resistance testing in 10 sentinel sites, which is an important contribution to the MOH’s resistance mapping. Finally, in 2018 ZAP DR continued in-service trainings on vector control and entomology monitoring for DPS staff and community volunteers. The project provided technical and financial support for the implementation of a second cohort of the diploma-level training program geared toward DPS staff led by the Universidad Autonoma de Santo Domingo (UASD). This program was designed with ZAP support in 2017, and through the end of the reporting period, 61 graduates are involved in vector control and entomology activities in 28 of the DR’s 32 provinces. To further build DPS capacity, ZAP DR designed a comprehensive DPS Strengthening Strategy. ZAP will implement the strategy in 2019 to consolidate successful progress, and document and systematize sustainable vector control and entomological monitoring practices among 16 targeted DPS across the country. 1 2. PROGRESS AND OUTCOMES 2.1 COMMUNITY MOBILIZATION, SOCIAL AND BEHAVIOR CHANGE COMMUNICATION In 2018, the Zika AIRS Project (ZAP) in the Dominican Republic (DR) used several community mobilization and social and behavior change communication (SBCC) strategies to achieve its objectives in vector control, entomological monitoring, and field implementation of insecticide resistance testing. Provincial health directorates (Direcciones Provinciales de Salud, DPSs) played an important role in interactions with target communities1. Community groups involved included neighborhood councils, community leaders, heads of school districts, and churches. ZAP also mobilized other partners such as daycare centers, nursing homes, and cemetery keepers.